The challenges and potential in developing microRNA associated with regeneration as biomarkers to improve prognostication for liver failure syndromes and hepatocellular carcinoma

ABSTRACT

Introduction

Determining the need for liver transplantation remains critical in the management of hepatocellular carcinoma (HCC) and liver failure syndromes (including acute liver failure and decompensated cirrhosis states). Conventional prognostic models utilize biomarkers of liver and non-liver failure and have limitations in their application. Novel biomarkers which predict regeneration may fulfil this niche. microRNA are implicated in health and disease and are present in abundance in the circulation. Despite this, they have not translated into mainstream clinical biomarkers.

Areas covered

We will discuss current challenges in the prognostication of patients with liver failure syndromes as well as for patients with HCC. We will discuss biomarkers implicated with liver regeneration. We then provide an overview of the challenges in developing microRNA into clinically tractable biomarkers. Finally, we will provide a scoping review of microRNA which may have potential as prognostic biomarkers in liver failure syndromes and HCC.

Expert opinion

Novel biomarkers are needed to improve prognostic models in liver failure syndromes and HCC. Biomarkers associated with liver regeneration are currently lacking and may fulfil this niche. microRNA have the potential to be developed into clinically tractable biomarkers but a consensus on standardizing methodology and reporting is required prior to large-scale studies.

KEYWORDS:

• Acute liver failure
• acute-on-chronic liver failure
• acute decompensation
• biomarker
• chronic liver disease
• hepatocellular carcinoma microRNA
• prognostication
• regeneration

Article highlights

• Conventional prognostic models for liver failure syndromes and hepatocellular carcinoma utilize conventional markers of liver and non-liver failure and have limitations in performance which impact on their utility

• Biomarkers associated with regeneration are currently lacking from prognostic models

• microRNA have been long been proposed as potential clinical biomarkers across numerous disease processes but have not translated into routine clinical practice due to a combination of target selection and lack of methodological standardization

• miR-122 has been repeatedly highlighted as a promising prognostic biomarker in both liver failure syndromes and hepatocellular carcinoma

• When grouped by biological processes, microRNA associated with regeneration are shown to have prognostic potential across liver failure syndromes and HCC and may improve conventional models

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737159.2023.2292642

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Tavabie OD wrote the first draft, Salehi S and Aluvihare VR made critical revisions, Tavabie OD, Salehi S and Aluvihare VR all were involved with the conceptualization of the manuscript and all approved the final version of the manuscript

Additional information

Funding

This paper was not funded.